BASL Monthly Payments Team Approval Request

THIS FORM IS ONLY FOR PLAYERS REGISTERED WITH THE BASL 12 CONSECUTIVE MONTHLY PAYMENTS PLAN!!

-Please fill out this form to notify BASL which teams you would like to apply your consecutive 12 payments towards.

-Make sure the captains have listed you on the roster before asking for approval.

-Make sure you list your team names EXACTLY as they are on the website. (ex: Dolphins Mens - Indoor)

Name
*FirstLast

Email
*

Mobile Phone Number
*###-###-####

I'm a
*

We will check to make sure that your on our player payment list and that you are on this plan

Teams that I wish to play on are:

Include teams that you are already approved on as well. We make sure that you are approved on all the teams listed here. If you already approved on other teams that you do not list here, you will be unapproved from those teams.

Please list which season also for your team as we have overlapping seasons. Thanks You.

Team 1

Example: Dolphins -Jax Indoor - Spring Season

Team 2

Example: Dolphins - Indoor - Spring Season

Team 3

Example: Dolphins - Indoor - Spring Season

Team 4

Example: Dolphins - Indoor - Spring Season

Are you a new payment plan (last 10 days)?
*

YesNo

Comments

Soccer is a contact sport involving risk of serious injury, disability or death. Not all risks are foreseeable.

In consideration of being permitted to participate in or assisting others in participating in BASL Soccer, and related events and/or activities, on behalf of myself, or a minor child or ward, heir; next of kin, personal representative, successor or assign;

(1) I ACKNOWLEDGE, UNDERSTAND, DECLARE AND AGREE THAT:
(a) To the best of my knowledge, I am in Good Physical Condition and have no disease or injury that would be aggravated by participating in activities related to the League;

(b) I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical physical conditions which could interfere with my safety in the activity, or else I am willing to assume and bear the costs that may be created, directly or indirectly, by any such condition;

(c) Participating or assisting others in participating in the League may involve RISK OF INJURY TO ME, INCLUDING DEATH, LOSS OR DAMAGE TO ME OR MY PROPERTY, or other consequences, which might result not only from my own actions, inaction or negligence but also the actions, inaction or negligence of others, the rules of play, or the conditions of the premises or of any equipment used;
(d) There may be OTHER RISKS not known or not reasonably foreseeable; and Understanding All of the above,

(2) I ASSUME ALL OF THE ABOVE RISKS AND RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, INDEMNIFY AND COVENANT NOT TO SUE:
(a) The United States Soccer Federation (USSF), the State of Florida or any of its agencies, the Florida State Soccer Association (FSSA), the Florida State Youth Soccer Association (FYSA), United States Specialty Sports Association (USSSA), the Beaches Adult Soccer League, Inc. (BASL), its commissioners, employees or volunteers, coaches, trainers, officials affiliated with the organizations, players involved in the games or not, agencies, sponsors, Or advertisers, the respective administrators, officers, directors, agents, representatives, employees, volunteers, coaches, trainers, officials or any other individuals affiliated with the League;
(b) Any affiliated subsidiary, successor, organization, or related companies or businesses, other participants, participating or sponsoring municipalities, governmental agencies, international organizations, agencies, sponsors, or advertisers, the respective administrators, officers, directors, agents, representatives, employees or volunteers of such entities or organizations, the successors, heirs, assigns, or the insurers or representatives, be it personal or business, of each aforementioned individual;
(c) Owners, lessors and lessees of premises used to conduct the Games FROM ANY AND ALL LIABILITY FOR INJURY; INCLUDING DEATH, LOSS OR DAMAGE TO PERSON OR PROPERTY, OR ANY OTHER CONSEQUENCE in connection with entry in or arising out of participation in, performance in or lack of performance in, including travel en route to and from the Games.

(3) I FURTHER AGREE THAT:
(a) Prior to participating as an athlete, I, or in the case of a minor, a parent or guardian, will INSPECT the facilities and equipment to be used, and if I believe same to be unsafe, I will immediately REPORT such condition(s) to the athletic coach, supervisor, or official connected with the Games of same and either DECLINE TO PARTICIPATE or ASSUME THE RISK of participating;
(b) I will ALLOW my PHOTOGRAPH, PICTURE or LIKENESS and/or VOICE to APPEAR in any official documentary, promotional (including any and all advertisements), television, and radio or film coverage of the Games, WITHOUT COMPENSATION.

(4) I CONSENT TO ALL EMERGENCY MEDICAL TREATMENT as may be deemed appropriate under existing circumstances by medical personnel or personnel associated with the Games.*